Evaluation of the use of independent study models.


A multidimensional tool for clinical evaluation.


Satisfying and stressful incidents reported by students during the first two years of a new baccalaureate programme in nursing.


Change and growth.

Change and growth.


The U.B.C. model for nursing: direction for nursing practice.


A model for nursing: University of British Columbia School of Nursing.


Baccalaureate preparation for the nurse practitioner: when will we ever learn?


A preliminary study designed to explore the difference in effectiveness of group and individual teaching in self-medication.


Response to "A preliminary study designed to explore the differences in effectiveness of group and individual teachings in self-medication".


A preliminary study on the effect of role modeling on anxiety in motor skill performance and the effect of self concept in motor skill performance.


Teaching continuity of care through post-hospital visits by the student nurse.


Education in nursing administration. Where are we and where should we be?


A cross-cultural study of the nursing role in ten countries.


Conversations in "the waiting room for death".


The phenomenon of caring. Part IV.

The phenomenon of caring. Part IV.


Need for better conditions of service for the Nigerian nurse.


The rate at which nurses explain procedures to patients in three hospitals in a state capital in Nigeria.


Cost of capital in nursing homes financing.


Deprivation and existence or stimulation and life: our choice for the elderly.


On being a more effective administrator through time management.


Press-button drugs.

Press-button drugs.


Personality dimensions and job satisfaction of nurses.


Teaching-learning process in nursing.

Teaching-learning process in nursing.


Our position in the health team.

Our position in the health team.


Narcolepsy. Diagnosis and treatment.

Narcolepsy. Diagnosis and treatment. Narcolepsy may affect as many as 200,000 Americans. The illness involves a neurologic defect in the regulation of sleep and wakefulness. The chief symptoms are sleepiness, inappropriate sleep episodes, and cataplexy. A characteristic history of cataplexy establishes the diagnosis. Narcoleptic patients also frequently complain of hypnagogic hallucinations, sleep paralysis, blackouts (or automatic behavior), and disturbed nocturnal sleep. Narcolepsy usually develops in adolescence and is a life-long illness. Symptoms may also appear in young children who may be misdiagnosed as hyperactive or psychotic. No completely satisfactory treatment is available at the present time. The current treatments of choice are methylphenidate (for sleepiness and sleep episodes) and imipramine (for cataplexy). Medication dosages must be adjusted for individual patients. A careful history of the illness can rule out hypothyroidism, hypoglycemia, and epilepsy. Sleep apnea is a serious complication of narcolepsy and may be life threatening.


Good nutritional practice. How to tell the nuts from the berries.


Psychological and physiological aspects of electronic fetal monitoring.


Renal homeostasis in the acutely injured patient.


Facial fractures.

Facial fractures.


Prenatal genetic counseling.

Prenatal genetic counseling. Current medical practice is using an increasing number of new and sophisticated techniques to deal with the fetus during pregnancy and not focusing exclusively on the immediate perinatal period. Some of these techniques deal with the occurrence or risk of serious genetic disease in the newborn. These procedures, which offer alternatives to the birth of seriously defective children, pose new problems in critical decision-making for contemporary parents. Proper medical care for the mother in such situations requires an understanding of the psychological as well as the medical and genetic aspects of each situation. It includes careful and caring communication of this information to the parents early in the gestational period, supportive care during the pregnancy and the procedures, and supportive counseling and follow-up afterwards. Properly applied, current genetic counseling diagnostic techniques as used by the physician can be extremely helpful to his patients in achieving the healthy family they desire.


The maternal sense of mastery in primary care obstetrics.


Coping mechanisms during childbirth and postpartum sequelae.


Personality factors and postpartum adjustment.


Changing perspectives on elective hysterectomy.


The Hopkins Symptom Checklist. Assessing emotional distress in obstetric-gynecologic practice.


Mastectomy. Sexual implications.

Mastectomy. Sexual implications.


Reactions to hysterectomy: fact or fiction? Elective hysterectomy has become culturally patterned as a normal part of the life cycle with more than half of all American women destined for hysterectomy if current rates continue. In keeping with this widespread acceptance, both women and their doctors frequently express satisfaction with the operation. The sequelae that do occur appear to be serious in only a few women, though more minor disturbances do appear in a sizable number. Repeated or controlled studies indicate that hysterectomy may yield problems for some women in the following areas: rejection by male partners,  hot flushes after conservation of ovarian tissue, severe hot flushes after ovariectomy, long-term psychourinary problems, weight changes, lingering fatigue and prolonged convalescence, painful intercourse, depression, sleep disturbances, and other psychiatric symptoms. Prospective studies using matched control groups are needed which follow patients at least 2 years postoperatively, as repeated studies have shown "sleeper effect" after hysterectomy with sequelae developing after the first 6 months or even after 1 year. The impact of varying surgical techniques and the long-term endocrine impact of hysterectomy need to be detailed as well as further study undertaken on the psychosomatic sequelae.


Psychological factors in gynecologic cancer.


Submission on inservice education.

Submission on inservice education.


Cancer nursing in the U.K. and the U.S.A.


The promises in your future.

The promises in your future.


A mouth burn need not disfigure a child.


An uncaring attitude taught me nursing care.


The minister was mortal.

The minister was mortal.


The Valley Trust: the nurse is the key.

The Valley Trust: the nurse is the key.


Respiratory distress.

Respiratory distress.


Development of nursing communication systems (patient-nurse call systems).


Harlequin fetus: a case study.

Harlequin fetus: a case study.


Report on overseas study tour: 1975.

Report on overseas study tour: 1975.


Our responsibility for political action.


At the GOP Convention: network nurses part of the action.


Follow-up: and follow-through.

Follow-up: and follow-through.


NLRB ruling: "domination" negated by recent decisions.


Effects of drugs on the foetus.

Effects of drugs on the foetus.


Caring in crisis.

Caring in crisis.


Nurse education -- a choice between higher and further education.


Emotional care and support: an overseas tour around burns units and centres.


Multi-disciplinary teamwork in health care.


Better services for the mentally ill and handicapped: paving the way.


Guidelines to play in hospital.

Guidelines to play in hospital.


Nursing care.

Nursing care.


The need for an adolescent ward.

The need for an adolescent ward.


Rape in the community.

Rape in the community.


Sturt College of Advanced Education. The school of health profession.


Sturt College of Advanced Education--Flinders Medical Centre Nursing Department. A conversation with students.


What is happening at Sturt?

What is happening at Sturt?


Clinical teaching in a basic tertiary nursing program.


Social and behavioral sciences in the diploma of nursing course.


Nursing care in year two.

Nursing care in year two.


Just a cystoscopy.

Just a cystoscopy.


Ferrogradumets.

Ferrogradumets.


Flinders Medical Centre.

Flinders Medical Centre.


Chinese medicine.

Chinese medicine.


Health and quiet breathing.

Health and quiet breathing.


Fourth special session of the Commission on Narcotic Drugs.


The incidence of drug use and associated factors in two small towns: a community survey. The article reports the results of a 1974 drug survey in two rural municipalities in the Pacific Northwest. Drug use in these towns was found to be similar to drug use in urban areas. It appears that towns size 2,500 to 50,000 have been absorbed into the national drug culture while only farmers and people living in very small towns still experience relatively low rates of drug use. Other findings include attitudes toward and needs met by drug use, the effect of parental drug use on perceived children's drug use, and the relationships between drug use and age, sex, and general health. In the past few years, articles have appeared describing adult drug use in the United States as a whole, or in selected urban populations. The most comprehensive study is a national survey of a representative sample of 2,552 adults completed in 1971 (1-3). Among the regional reports are studies carried out in California (4,5) and New York (6,7). What these studies have in common is the absence of data on rural or small town drug use as compared with urban drug use. A national study by Cahalan, Cisin, and Crossley (8) does analyse rural-urban differences, but only for alcohol use. No comprehensive treatment of this topic exists in the literature. The research reported in the present article represents an attempt to begin to fill in this void data on small town drug use in a rural setting.


[Nurse-midwives and adolescents: the South Carolina experiment].


Liberian obstetrics. Part 1. The birth and development of midwifery.


The nurse-midwifery management of physiological edema in pregnancy.


Nurse-midwifery and ethics...a beginning.


We have major decisions to make.

We have major decisions to make.


Drug dependency in Norway: use and abuse of dependency-producing drugs; treatment facilities; follow-up studies; prophylactic measures.


Metal ion content of specific areas of the rat brain after 1600 MHz radiofrequency irradiation. Rats were exposed to a hyperthermal environment or 1600 MHz radiation for 10 minutes to achieve equivalent rectal temperature increase (4 degrees C). Brain areas were quantitatively assayed for changes in magnesium, calcium, copper, zinc, iron, sodium, and potassium. Iron was increased in several brain regions of both hyperthermal and irradiated animals. Copper content of the cortex was also increased in both experimental groups, whereas zinc was decreased in the hypothalamus. Magnesium was increased in the cortex and medulla of the irradiated rats.


Contribution to the study of drug dependence among young people in Caracas.


A note on the cannabinoid content of Jamaican ganja. There has been considerable recent interest in the study of Jamaican ganja users as a potentially valuable source of information on the effects of long-term cannabis consumption. However, reported data on the cannabinoid content of Jamaican material have been limited to those of Rubin and Comitas for a small number of samples of unknown representativeness. In the present study, the cannabinoid content was determined on 36 samples purchased from various ganja dealers at two different periods, derived from crops treated differently with respect to fertilization, and representing the range of types locally considered to differ in quality or potency. The analytical results agreed well with those of Rubin and Comitas, and indicated that samples with a delta9-THC content of 4.0% or more were apt to be comparatively rare. The median value was 2.3% by weight. Some of the variation in the THC content of the samples was clearly attributable to the different seasons in which they were purchased, and some may have been due to differences in the type of fertilizer used in cultivation. Local judgement as to the potency of samples proved generally sound, although by no means infallible.


Separation of cannabinoids.

Separation of cannabinoids. The three main cannabinoids--cannabidiol (CBD), tetrahydrocannabinol (THC) and cannabinol (CBN)-can be isolated from purified extract of cannabis by preparative gas chromatography in satisfactory amounts and with a degree of purity similar to that of the sample substances provided by the United Nations Narcotics Laboratory.


Interdisciplinary education: a model for the resocialization of faculty.


The influence of will on life and death.


Attachment/separation in the nurse-patient relationship.


Family life among mainland Puerto Ricans in New York City slums. Puerto Rican families who migrated to New York City in the 1950s are threatened by a system of impersonal relationships and norms which are at odds with their traditional values.  Puerto Rican families have a tendency to have many children.  A woman must have a child as soon as possible after marriage to show the community and her husband that she is fertile.  They are forbidden by their husbands to use contraceptives, and most Puerto Rican men refuse to use contraceptives because of a machismo complex.  Many of the women resort to sterilization.  Common-law marriages are found frequently among the lower socioeconomic families.  Mainland Puerto Rican families find problems trying to raise girls as virgins and boys with sexual freedom.  The daughters want to adopt the dominant pattern of mainland society.


Effective community health nursing: a framework for actualizing standards of practice.


Innate factors in sex differences.

Innate factors in sex differences.


Homosexuality: a different sexual orientation.


Sexuality in the baccalaureate nursing curriculum. One hundred and fifty-one baccalaureate nursing programs responded to a survey indicating how and to what extent concepts of human sexuality were incorporated into the nursing curricula. A majority of programs provided for all topic areas listed on the questionnaire with those related to reproduction being most prevalent in the curricula. Most respondents believed that baccalaureate graduates should be able to provide sex education for youth, counsel regarding healthy sex function, minimize the incidence of sexual dysfunction by educating adults, and counsel clients regarding sexual problems after illness or surgery. In nearly every instance, there was a perceived gap between what the curriculum provided and between the graduates' knowledge and competencies.


Nursing care of patients with pain.

Nursing care of patients with pain.


Role of nursing in India today.

Role of nursing in India today.


Erikson's theory of personality development as applied to the black child.


The consumer movement: the implications for psychiatric care.


The relevance of racism to the goals of  psychotherapy.


On "the oppressed majority", a few questions for nurses.


Structuring the black family for survival and growth. The options presented in this article provide an additional frame of reference for understanding some of the relationships between the parts, the whole, and the environment in which they exist, on the assumption that a "holistic" view may give a more accurate picture of the problem, as well as suggest some possible solutions. The black family, as the primary unit of socialization for the black community, must maximize the survival and facilitate the growth of its members. From a social systems persepctive, the relationship of the black family's internal structure to the external environment provides important insights. Internal boundaries must be firm but permeable to maximize both survival (firm boundaries) and growth (permeable boundaries). Assaults from the external environment must be managed to provide psychic relief for family members. What becomes clear, in structuring the black family to cope with boundary intrusions, is the way in which family members can organize, prepare, and preserve the integrity of the family system without losing sight of the task.


Secretory and structural effects of 6-hydroxy-dopamine on normal parotid glands of rats, and at different times after surgical sympathectomy. The effects of i.v. 6-hydroxydopamine (6-OHDA), 100 mg/kg, have been studied on parotid glands of rats at 12, 24, 48, 72 hr and 3 weeks after avulsion of the right superior cervical sympathetic ganglion. The salivary flow from normal left control glands and from right glands 12 hr after ganglionectomy were similar, but at longer times after ganglionectomy the secretory response from the test glands was greatly reduced. Morphological assessment showed that 6-OHDA induced a massive depletion of secretory granules from all control glands and also at 12 hr after ganglionectomy but at 48 and 72 hr there was considerably less depletion of granules on the ganglionectomized side. It is thought that at the longer times after ganglionectomy the secretion from the test glands is caused by circulating catecholamines released by the action of 6-OHDS on adrenergic nerves elsewhere, plus a possible small direct secretogogue effect oomy are thought to be attributable to the release of catecholamines from adrenergic nerves within the gland.


Changes in urinary water and electrolyte excretion in sodium-loaded sheep in response to intravenous infusion of arginine vasopressin. Mature sheep receiving supplements of sodium chloride into the rumen were given intravenous infusions of arginine vasopressin at rates varying from 4-6-23 pmol/min (2-10 mU/min). Infusion of the hormone led to an increase in urine flow and to increases in the amounts of sodium and chloride excreted, the effect on flow was, however, the greater so that the osmolality of the urine fell during the infusions. In sheep given intravenous infusions of a hypertonic sodium chloride solution addition of vasopressin to the infusate led to the formation of a larger volume of urine containing a higher proportion of the infused salt load compared to when the salt solution alone was given. As before the effect on flow was the greater and hence the osmolality of the urine was lower when the hormone was given. In other experiments intravenous infusion of a hypertonic sodium chloride solution at rates providing 2-8 mmol NaCl/min led to increases in urine flow and increases in sodium and chloride excretion, the size of these increases being proportional to infusion rate. Plasma vasopressin levels markedly increased during these infusions, the levels seen being similar to those seen in sheep given vasopressin in amounts which increased both urine flow and electrolyte excretion. This suggests that during hypertonic salt loading vasopressin probably contributes directly to the increases in urine flow and the increases in electrolyte excretion which are seen. Further evidence in support of this was obtained in experiments in which a greater natriuretic response was seen in sheep given a hypertonic sodium chloride solution into the carotid artery as opposed to the given a hypertonic sodium chloride solution into the carotid artery as opposed to the jugular vein and where it was shown that plasma vasopressin levels were indeed higher when the solution was given into the artery.


Divergent changes in the rate of development of pressure in the left ventricle and in the performance of the heart as a pump. Dog hearts were prepared in situ so that heart rate (HR), left ventricular end diastolic pressure (LVEDP) and mean aortic pressure (MAP) could be controlled separately during computation of left ventricular dP/dt max and external stroke work (SW). Progressive increases in HR consistently raised dP/dt max over a wide range, and consistently lowered SW except at low rates. Progressive increases in LVEDP or MAP consistently raised both dP/dt max and SW. Infusion of noradrenaline consistently raided both dP/dt max and SW, except at very high HR when only dP/dt max was consistently raised. Our results lead us to question the validity of equating changes in pre-ejection measurements with changes in performance of the heart as a pump under abnormal conditions and in the assessment of inotropic agents.


The effect of cholesterol oleate treatment of mice on the rosette forming cell response against sheep erythrocytes. Mice injected with a single dose of 60 mg cholesterol oleate emulsion showed substantial blockade of the monoclear phagocyte system measured by the rate of vascular clearance of radio-labelled sheep erythrocytes. The labelled rythrocytes, in lipid treated mice, localized mainly in the spleen, contrasting with control mice in which localization was mainly in the liver. Treatment with this lipid, 24 hr before the intravenous of two different doses of sheep erythrocytes, resulted in significant depression of the rosette forming cell response in the spleen, whereas the responses in the lymph nodes of both control and lipid treated mice were at a low level and not significantly different. Intravenously administered cholesterol oleate emulsion is known to localize mainly in the Kupffer cells and in splenic red pulp macrophages. Cultured macrophages treated with this lipid show inhibition of antigen-binding and depressed phagocytosis of heterologous erythrocytes. The lipid does not affect lymphocytes. These findings are in keeping with the hypothesis that macrophages play a direct role in the induction of an immune response against a particulate antigen.


Do nurses really see themselves as oppressed?


Barriers to the black and white therapeutic relationship.


Annual Convention proceedings; May 14-15, 1976.


Employment and conditions of work and life of nursing personnel.


Stay tuned for fresh disasters.

Stay tuned for fresh disasters.


Hospital health service for development.


How do we care?

How do we care?


Relationship of sodium, intravascular coagulation, and respiratory distress.


The dismissal of a registered nurse.

The dismissal of a registered nurse.


The first step of the giant's stride.

The first step of the giant's stride.


Otitis interna-I: General considerations. Number twelve in a series.


In vitro activity of antimicrobial agents against Pityrosporum canis.


A technique for feline onychectomy.

A technique for feline onychectomy.


Chronic urethral obstruction in a cat.

Chronic urethral obstruction in a cat.


Renal calculi in a dog. A four-year clinical picture.


The versatile cast saw.

The versatile cast saw.


Extra-uterine pregnancy in a spayed cat.


Prevention of clostridial disease in cattle and sheep by vaccination with a multivalent bacterin-toxoid.


The current status of swine dysentery.

The current status of swine dysentery.


Clinical studies of ketamine HCl and xylazine HCl in domestic goats.


The effect of parenteral acepromazine and xylazine on intraocular pressure in the horse.


Dental prophylaxis for a lowland gorilla.


Use of a nictitans flap in treating bovine keratoconjunctivitis.


Evaluation of an enteric-coated microencapsulated formulation of trichlorfon in horses.


Don't overlook additional first-year depreciation.


How to work smarter--not harder.

How to work smarter--not harder.


A frank talk about money.

A frank talk about money.


Survey of workload of public health nurses.


Collection of mid-stream specimens of urine. A review and costing of a routine nursing procedure.


Continuing nursing education - what is it? Who does it? Where is it going?


A new perspective on the health of Canadians.


Nurse classification system subject of recent criticism.


On the reimbursement of services for nurses.


Committee recommends separate organization for State Board.


ANA code for nurses revised, greater focus on nurse, client.


Problems of dialyzing children with adults in a small hemodialysis unit.


An experiment in primary nursing.

An experiment in primary nursing.


Geriatric considerations associated with maintenance dialysis.


Ultrafiltration study of the Gambro Lundia Nova 13.5 and 17 Micron hemodialyzers.


Nutritional care of the brain damaged patient.


A view on inter-organization relationships.


Psychosexual adjustment of spinal man and the multidisciplinary approach to patient care.


The team approach to the cardio-pulmonary patient.


ARN: the national view; a growing professional organization.


Obstetric delivery tomorrow: towards a curvilinear compromise.


A better approach to child care at the hospital outpatients through an under fives' clinic.


Study of the incidence of consanguinity in children.


Cow's urine poisoning in Nigeria: the cardiotoxic effects of cow's urine concoction on anaesthetized cats.


Medical education: team training of physicians in Cameroon. Training of generalist physicians for Third World Needs.


Infantile spasms in a Malaysian population. Clinical and EEG studies at initial presentation.


The importance of neonatal care routines.


The traditional birth attendant and neonatal tetanus: the Malaysian experience.


Aspects of ecology of food and nutrition in Peninsular Malaysia.


Breastfeeding as a contraceptive method among a low income group of of Tehrani women.


Neonatal morbidity and mortiality in Ibadan: a review of cases seen in the out-patient clinic.


Dental caries in primary school children of tirupati.


A guide for the dietary evaluation of preschool children in the health center.


Attitudes and practices of physicians concerning breast-feeding and its management. The attitudes and practices of a selected sample of American obstetricians and pediatricians was studied in an effort to gain insight into why more mothers do not choose to breast feed their babies and why many mothers, who really want to breast feed, are unsuccessful in their attempts.  Emphasis was on studying physicians' attitudes toward the general value of breast feeding and to the practical advice and help they give to mothers who want to breast feed their children.  The names and addresses of a total of 205 physicians were obtained from the 1974-1975 Directory of the Los Angeles County Medical Association.  The final sample included 105 obstetricians and 73 pediatricians.  A 5-page self-administered questionnaire was mailed to all physicians in both samples.  46 usable obstetrician questionnaires and 52 usable pediatrician questionnaires were returned.  58% of the pediatricians as compared to 38% of the obsteticians said that breast feeding was "very important."  None of the pediatricians said that breast feeding was "not very important" and only 4% reported neutral feelings about it.  33% of the obstricians gave these answers.  It was not possible to determine the specific reasons why the physicians felt that breast feeding was or was not important.  Only 30% of the physicians indicated that they routinely try to persuade their patients to breast feed.  52% said they would try to persuade a mother to breast feed only if she expressed an interest in it.  42% replied that they would encourage an undecided mother to breast feed.  Many questions regarding the type of advice given by the physicians were concerned with the lactation management practices which are considered to make a crucial difference between success and difficulty.  73% of the total sample indicated that they discuss nursing techniques but only a minority reported that they give their patients either a prenatal or postnatal talk about the anatomy of the breast and the "let-down reflex."  42% of the pediatricians as compared to 7% of the obstetricians correctly instructed mothers to wash their nipples with water only.  Books and other individuals (65% and 64%, respectively) were physicians' sources of breast feeding information.  The study findings indicate that the attitude of American physicians towards breast feeding is generally 1 of indifference with pediatricians appearing more interested in and knowledgeable about breast feeding than obstetricians.


Psychiatric hazards in Kenya.

Psychiatric hazards in Kenya.


Paralytic diseases of childhood in the tropics.


The electrocardiogram and the nurse. Part I - an introduction to the normal heart.


Venereal diseases (sexually transmitted diseases).


Health education principles and practices - a critical review.


The nurse and her/his integrity.

The nurse and her/his integrity.


Job satisfaction.

Job satisfaction.


Workstudy & its place in effective patient care.


Learning to live with yourself and mental health part.


International Federation of Gynaecology and Obstetrics definition of the midwife.


Problems of nursing.

Problems of nursing.


The struggles inside nursing's body politic.


The struggles outside nursing's body politic.


Physical assessment in nursing.

Physical assessment in nursing.


The dead end of altruism: a note to nurses.


Professionalism and unionism: conflicting ideologies.


Nursing's dilemma: male versus female admissions choice.


The male nurse: a challenge to traditional role identities.


Human relations with the sick and varying age groups.


Nursing practice and health service.

Nursing practice and health service.


Nursing in transition.

Nursing in transition.


The nurse as an agent of change.

The nurse as an agent of change.


The challenge of bacterial meningitis.

The challenge of bacterial meningitis.


"Concepts which influence health and health care".


The phenomenon of caring. Part II.

The phenomenon of caring. Part II.


The nurse for the 1980's.

The nurse for the 1980's.


A day in the life of a rural health centre nurse.


Water therapy.

Water therapy.


The disordered world of the patient with schizophrenia.


Human rights guidelines for nurses.

Human rights guidelines for nurses.


"Cross-cultural inferences of patient suffering".


The child on developmental assessment.

The child on developmental assessment.


Towards preservation of mental health.

Towards preservation of mental health.


Identification of patients using personal data from computer-based files.


Ethico-legal aspects of nursing practice.


Collective bargaining, a tool for patient care.


Human violence.

Human violence.


The advanced clinical nurse (ACN) and the health team.


Lecture to Rhodesia Nurses' Association 8th May, 1976. Some practical aspects of immunity.


A comparative trial of minocycline and cloxacillin in the treatment of soft tissue infections due to tetracycline resistant Staphylococcus aureus.


The structure and function of ferritin.

The structure and function of ferritin.


Transferrin: physiology and function in iron transport. Since its identification about 30 years ago transferrin has attracted the interest of many investigators concerned with its structure, metal-binding properties, genetic polymorphism, and especially its role in the transport of iron within the body. Transferrin's two iron-binding sites appear to be structurally identical with equivalent iron binding after addition of iron in vitro. However, since the experiments of Fletcher and Huehns, the functional homogeneity of transferrin-bound iron has been questioned. Understanding of the precise mechanism of iron release from transferrin to receptor sites on reticulocytes and other tissues active in iron exchange is incomplete. Considerable evidence has been assembled from rats to support the Fletcher-Huehns hypothesis of selective release of A-site iron to erythrocyte precursors and placenta while B-site iron is delivered to hepatocytes. Results of experiments in rabbit and human systems remain controversial. Reasons for this controversy include: variations in the technique of iron addition to transferrin with the possibility of non-specific binding; variations in reticulocytes used in preparing selectively labelled transferrin and in its biological assay; and artifacts introduced in mixed-species experiments. Until methods are more refined and the transferrin-iron receptor interaction is better understood, the controversy about transferrins's iron transport function will persist.


Control of iron delivery to haemoglobin in erythroid cells. This paper reviews and reports the results of experiments on the mechanism by which iron is delivered from extracellular transferrin to reticulocyte mitochondria in which haem is synthesized. It is suggested that transferrin donates the iron directly to mitochondria. Transferrin seems to be bound to mitochondria during the process of iron release. When the release of iron from transferrin is blocked by haem, the iron-transferrin complex remains bound to mitochondria so that the total amount of transferrin molecules associated with mitochondria increases in haem-treated reticulocytes. This also leads to an increase in the number of transferrin molecules in the cytosol. In haem-deficient reticulocytes, the rate of dissociation of iron from transferrin is accelerated and the uptake of iron by mitochondria is increased. When the synthesis of haem is inhibited, the non-haem iron in the cytosol (i.e. mainly low-molecular-weight and ferritin iron) comes from mitochondria. Greater amounts of non-haem iron can also be induced in reticulocytes incubated with highly saturated transferrin but, in this case, iron does not seem to be accumulated in mitochondria. These results represent an experimental basis for the elucidation of the excessive non-haem iron accumulation in erythroid cells observed in various clinical conditions.


Monoamine metabolism and platelet function in iron-deficiency anaemia.


Haem synthesis in sideroblastic anaemia.


Some physicochemical aspects of iron metabolism.


Iron kinetics and erythropoiesis.

Iron kinetics and erythropoiesis.


Biogenic monoamine metabolism and functional activity in iron-deficient rats: behavioural correlates.


The development of agricultural antibiotics in Japan. Agricultural antibiotics are very hopeful biodegradable pesticides which are expected to be from environmental pollution. The outline of the present status of agricultural antibiotics used or tested at present for practical application in Japan is presental in this paper.


The new mother's view of herself.

The new mother's view of herself. A woman's attitude to breast-feeding is usually determined more by feeling than by rational thought; it is built on her adolescent views of the development of secondary sexual characteristics and subsequently on the breasts' part in sexual attraction. Early in pregnancy a mother is aware that fixed advice is more often offered than explanatory discussion. When birth is imminent, disinclination to breast-feed may be part of an unrecognized reluctance to submit to the changes which motherhood will bring. After the birth of her first child a mother finds herself enduring the discomforts of heightened moods and only too ready to interpret difficulties as signs of her inadequacy. Yet at the same time she is likely to discover her delight in her baby's repose and her own tranquillity at times of feeding.


General discussion I: haemosiderin.

General discussion I: haemosiderin.


The effect of early mother-infant contact on breast feeding, infection and growth.


Iron centres and rate-limiting spans in the respiratory chains of mitochondria from adult and fetal rats. The respiratory chain is a mosaic of complexes functionally linked through the mobile intermediates ubiquinone and cytochrome c. Changes in content of complexes that are not rat-limiting might not be reflected in the overall respiratory rate but may be revealed by titration with specific inhibitors. Oxidation of succinate by membranes of liver mitochondria from fetal, adult and starved rats was titrated with antimycin. Initial respiratory rates were similar but antimycin-titration curves were markedly different. The results indicate that the content of Complex III (cytochrome b-c1 span) is much lower in mitochondria from fetal and starved adult rats than in controls. In no case however is Complex III initially rat-limiting, and in fetal and starved adult rats it seems that a much lower content of functional Complex III is required to sustain a given respiratory rate. A possible explanation is a compensatory optimization of the pool function of ubiquinone, through increases in its content or its mobility in the mitochondrial membrane.


Cross-cultural aspects of breast-feeding.


Lysosomal disruption in the pathogenesis of hepatic damage in primary and secondary haemochromatosis. The disruption of lysosomes with release of their content of lytic enzymes was an early concept for the possible role of these organelles in the pathogenesis of tissue damage. Many examples are known of primary lysosomal storage diseases due to a congenital deficiency of certain acid hydrolases. It is suggested that iron overload due to either primary haemochromatosis or transfusional siderosis is a form of acquired secondary lysosomal storage disease. Subcellular fractionation experiments and electron microscopic studies have shown that liver tissue from patients with iron overload has iron-laden lysosomes. Similar results have been found in iron-overloaded rats. In patients, but not in experimental animals, enzymic analyses have shown increased activities of acid hydrolases and strikingly enhanced lysosomal fragility in liver homogenates. When it has been possible to deplete the patients of the excessive iron, these parameters have returned to normal. The possible mechanisms by which the iron compounds disrupt lysosomes, including distension with ferritin or haemosiderin or free-radical-mediated membrane damage, will be discussed.


An intracellular transit iron pool.

An intracellular transit iron pool. It seems likely that iron which has crossed the cell membrane and has been released from transferrin enters a labile intermediate pool from which it is available for haem synthesis, for the activation of iron-dependent enzymes, for incorporation into ferritin or for a return to extracellular transferrin. Enlargement of this pool stimulates ferritin synthesis. Iron probably enters the transit pool not only from transferrin but also as a result of endogenous haem breakdown and the mobilization of ferritin iron. Evidence for the occurrence of the transit pool has been obtained for reticuloendothelial cells, red cells precursors, cultured Chang cells and liver. It is suggested that the transit pool consists of a low molecular weight complex and that this is a major source of the iron chelated by agents such as desferrioxamine. No more precise characterization has been possible up to the present time.


Every life needs nutritional and emotional satisfaction: the midwife's opportunity.


Lactation education: the learning of the 'obvious'. As far as the human mother is concerned, breast-feeding is hardly an instinctive act. Its success is based on the transmittal of accumulated experience in how to tackle breast-feeding problems. In rural societies where this experience is still intact and the mothers are well supported in the period just after the birth of the child, the best policy is non-interference. In transitional and urban societies, however, the traditional know-how and support is often lost, and failure to breast-feed usually results; here, lactation education is in its place. The knowledge of health personnel about how to teach mothers to breast-feed is often scanty. Medical text-books are weak on this point--more often than not, the information given is a mere extrapolation of bottle-feeding techniques to breast-feeding. Re-education is necessary, so that the advice given to mothers is simple, uniform and based on experience and insight. 'Moralizing' is unnecessary and should be avoided. There are several channels for the spreading of information about breast-feeding: mothers' groups, health services in general, mass media and schools. The importance of the policy makers should not be overlooked: at least in urban areas, several of their decisions will finally affect the method of infant feeding.


Breast-feeding and the mother: general discussion.


Iron status, immune response and susceptibility to infection. Nutritional factors can modulate immune responses. The concentration of iron, amongst other nutrients, influences host defence mechanisms. In experimentally induced iron deficiency in animals, morbidity and mortality on bacterial challenge are increased several-fold. Cell-mediated immunity and intra-cellular bacterial killing by polymorphonuclear leucocytes are impaired in iron-deficient individuals. This impairment is likely to be mediated by the effect of iron lack on cell proliferation, DNA synthesis and activity of iron-containing and iron-dependent enzymes involved in killing and elimination of microbes. Conversely, the availability of the free iron is a critical determinant for bacterial multiplication. It is not surprising then that epidemiological and clinical data on the frequency of infections--bacterial, fungal and others--in iron-deficient, iron-overloaded and healthy groups differ so widely. Vulnerability to infection based on the individual's iron status must be the net result of the effect of iron, or the lack of it, on microbial growth on the one hand and on immunocompetence of the host on the other. The key to keeping these interactions within physiological bounds is 'optimal iron nutrition'.


The place of academic research.

The place of academic research. The medically qualified academic research worker under university aegis but within the National Health Service has recently been subjected to frightening forces. His traditional role of being allowed and financed to do what he wants is questioned in an age of economic crisis and of concern about how to spend limited resources. The call for 'relevance' in academic research makes sense when looked at from society's viewpoint but nonsense when looked at from the research worker's viewpoint. Recent personal experience has generated a proposal for the resolution, in part, of these conflicting claims; namely, the university hospital. Unless academic research continues to flourish within our present framework, the quality of the practitioners of medicine and paramedical subjects will drop slowly over the next 20 years as the spirit of enquiry dies!


The response of the hospital doctor to the health requirements of a changing society. Before the advent of the National Health Service in 1948 most hospital doctors were in close contact with the primary care of, at least, a section of the community both by their continuing close contacts with general practitioners and as a result of often having spent some part of their careers as general practitioners. Since 1948 this awareness of the health aspirations of the community has weakened as a result of advances in the care of disease which have made the hospital doctor increasingly dependent on sophisticated facilities and, thus, focused his attention on hospital care rather than on the community. Hospital staff must re-establish their link with primary care and must perceive clearly the ways in which they contribute to the health of their community. They must be conscious of the proportion of available resources that are used in hospital and be prepared to regulate demands so that there is equality in the distribution of resources in the health field. Hospitals are not only expensive but have become extravagant; it is the responsibility of the hospital doctor to curb extravagance. If private practice is to continue, it must be integrated into the health service, not excluded from it. Finally, the patient must be recognized as a member of a family and of a community that is both curious and concerned about health. The hospital doctor must communicate with patience, understanding and clarity. In this relationship he also has a part to play in health education and prevention of disease. He must remove the mystery from his art and enter into useful discussions with government and community.


The liver in thalassaemia major: ultrastructural observations. During a study of pathogenetic mechanisms in the hepatic cirrhosis of thalassaemia major, 16 liver biopsies were examined by electron microscopy. Previous ultrastructural studies of liver cells during iron overload have shown electron-dense iron as lysosomal haemosiderin, and as lysosomal and cell-sap ferritin. In this study, all biopsies, regardless of the patient's age, showed ferritin molecules within lysosomes in a specific pattern in relationship with regularly arranged lamellae. This membrane-associated lysosomal ferritin is considered to be a stage in the segregation of iron seen in iron overload. The dimensions and electron density of individual ferritin molecules indicate differences between cell sap and lysosomal ferritin. Intracellular ferritin transport and iron-seclusion mechanisms are reconsidered in view of these findings. The liver biopsies of thalassaemic infants also provide information about the causal relationship between iron overload and collagen deposition. Since the collagen deposition precedes any morphological evidence of cellular injury (other than the increased iron content), the primary cirrhotogenic factor in thalassaemia is apparently not cell necrosis but possibly excessive collagen deposition induced by iron.


Health education, cancer and postgraduate training. Cancer as a term encompasses a multitude of diseases and is consequently misunderstood. Today, it is still considered sinister and, too often, synonymous with death. It is a complex subject, exciting and challenging, yet the myths associated with cancer are perpetuated even by professionals in the health service. This can be attributed to the scant knowledge of its nature and prognosis, the progress made and the services available. When one considers the breadth of basic training needed to prepare both doctors and nurses to practise it is understandable. In a health service based on disease it is difficult to consider prevention as a priority. Financial implications are enormous and inhibit this aspect of the work in thefield of cancer and allied diseases. However, it is estimated that 80--90% of cancers are caused by environmental influences and can, in theory, be prevented. Efforts to promote health and prevent disease are costly and too often ineffective. Early diagnosis is another contentious subject; efforts are being directed to the establishment of clinics for patients presenting with symptoms rather than detection of symptom-free subjects. Improved approaches to prevention, recognition and acceptance through an understanding of cancer will alleviate the task of those directly involved in the cure and control of the disease. Health education in relation to cancer needs to be directed equally at health service professionals and the public. It would be unacceptable and inaccurate to describe the cancer services anywhere as incapable of further improvement. Research and therapy must go hand in hand and depend on the participation of the patient as a knowledgeable member of the team, rather than as a passive recipient of care. Death should not be considered failure, rather the completion of care. We face constantly the risk of despondency and the efforts of the team must be sustained with optimism and encouragement. Achievements have been made and will be made, however slowly, and the end justifies the effort. The need for postgraduate training is greater now than ever before. Adaptability to rapid change, vision and continuity are vital in our technologically orientated society. This should be considered a prerequisite to ensure improved standards of patient care at home and in hospital.


Women and their health: is there a conflict?


The difficulties of changing.

The difficulties of changing. In general, our psychological equipment develops in such a way that we get information of predictive value through the senses; we tend to record constancies and consistencies of events and behave as though these are persistent. We are mostly unaware of the power of the stores of relevant experience (assumptions, expectations, attitudes) that condition our perceptions and therefore cannot question them, nor in many circumstances is there need to do so. In fairly constant conditions they are useful in helping us to see, quickly and effortlessly, what we expect to see. But in rapid changes this is not so; we can no longer rely on our psychological equipment and we become uncertain, confused and, in extreme cases, antagonistic, fearful and impotent. Examples of assumptions that influence medical education and medical treatment are given. Ability to respond effectively to change requires confidence to examine and restructure basic assumptions. The value of interaction in small groups in helping to achieve this is indicated.


The reorganized National Health Service: theory and reality.


Implications of shortening the time spent in hospital. The decision to shorten the time spent in most areas of hospital care is extremely complex and hinges on the balance of numerous resulting credits and debits, which are largely unknown. The length of stay in hospital can be stabilized for many categories of medical care but the likely benefits may be disappointingly small in the face of unchanged demand for health care. Furthermore, a sustained reduction in length of stay could bring with it logistic contractual and personal problems, the costs of which could outweigh the benefits of stabilization. The best delivery of health care in a closed financial system seems to depend on a joint consideration of output per unit time and a provision of a service that comes near to satisfying the true need for that service. The appropriate level of service will be decided from a study of the true prevalence of the need and the ability of the service to satisfy it. The enthusiastic pursuit of traditional efficiency without adequate information may be counterproductive--by increasing demand, by demoralizing the health personnel and by diverting some of the demand into private practice. Our first priority is the rationalization of demand; this will need the combined efforts and goodwill of the consumer and the supplier. Only when demand has been rationalized may we expect a net benefit from shortening length of stay.


Ferritin phenotypes: structure and metabolism. Recent advances in our understanding of the biochemistry of ferritin have provided new insights into its role in iron metabolism. Findings of multiple structural forms in many tissues may have important consequences for ferritin's function and metabolism. This article reviews the molecular basis of apoferritin heterogeneity and discusses mechanisms operating in the phenotypic expression of ferritin in normal and malignant cells.


The nurse's contribution to care.

The nurse's contribution to care. The concept of health needs as envisaged by the nurse and the challenge of the changing setting to nursing are explored with regard to the nurse's contribution to care against the background of change. Advances in medical science and technology tend to result in increasing specialization in health care and a complex organizational structure for its delivery. These and other factors tend towards fragmentation of care. Care is the concern of all health workers and needs collaboration based on mutual trust and respect. The nurse makes not the only but a unique contribution to care. In the primary care team she has information about the patient as a 'whole' person and about his or her family on the basis of which she can assess total needs and make appropriate arrangements for these to be met. She communicates with the medical and other members of the health professions in the interest of coordinated and total care, including continuity of care between home and hospital, where appropriate. In hospital, nurses are the only professional workers providing a continuous and direct caring service. Care is a concept implying a measure of constancy and continuity. These two aspects, reinforced by communication, coordination, explanation, education and empathy, are some of the main components in the nurse's contribution to care.


Some quandaries facing the health visitor in these times of change,. Several dilemmas face personnel in the National Health Service as they endeavour to provide quality care while both costs and the level of consumer expectation rise. Amongst the specific aspects of concern to the health visitor are, in particular, role perceptions and role expansion, the problems consequent upon the integration of preventive workers within traditionally curative settings, the perplexities of those concerned with the rightful deployment of skills and resources within the primary health care team, and the need to create group cohesion and efficiency against a background of different professional cultural heritages. The changing pattern of disease raises several issues, in particular the contribution that health visitors might make to the total health care system. The overall aim is to examine a few of the areas where there may be conflict and to look at the way in which such conflicts could be harnessed for further cooperation and communication, so improving group harmony and community health care.


Commitment and concern in the health service. As part of a general review of the use of local health services resources, a specific enquiry was mounted to examine the recurring complaint of a lack of identity or sense of belonging made by staff working in the largest district of the Grampian Health Board. The investigation pointed to clearly identifiable sources of confusion and concern: (a) a need to identify with and feel committed to the health service; (b) a sense of purpose and direction; (c) satisfaction with the conditions of service; (d) an understanding of an individual's role and its relationship to others'. It is relatively easy to list the problems, such as friction between occupational groups, lack of commitment, uncertainty over duties and authority, reluctance to delegate and resistance to, or even outright rejection of, decisions apparently at variance with professional advice. In addition to these internal stresses the health service is perpetually beset by two other external problems, namely what it is expected to achieve and the finance allowed to attain its goals. The various groups within the service are in no way agreed on roles and responsibilities, Without agreement goals cannot be defined. Without goals, use of resources cannot be rationalized. Without a demonstrably fair distribution of resources, neither the public nor health service staff will feel confident or committed. Somewhere this cycle must be broken.


Research and medical practice: their interaction. Introduction.


French medical research: the risk of 'demedicalization'. French medical research is at present financed almost entirely by INSERM (Institut National de la Santé et de la Recherceh Médicale). The INSERM budget (286 million francs in 1975) supports research in laboratoreis in university hospitals by doctors who have both clinical and teaching commitments and, especially, by more than a thousand 'statutory research workers' employed by INSERM. Research in INSERM laboratories now tends to be fundamental biological research rather than directed towards pathological problems. Among the reasons for this are (i) the mode of recruitment of staturtory research workers; (ii) the difficulties of clinical investigation, which are due mainly to the way the hospitals function and to lack of interest by the hospital administration in medical research; (iii) the small number of university doctors actively involved in research. Research on fundamental biological problems in INSERM laboratories is making excellent progress, due to the quality of the research workers, and it may pay in the long run. But medical research is now tending to become an 'ivory tower' for the victorious researchers, who sometimes scorn the clinicians. Medical research will, if no measures are taken, 'demedicalize.' Institutes of pure biological research could soon be isolated within the medical faculties and doctors may become even less scientific and investigative than they are today. This situation could be modified by: (i) re-evaluating the role of research in a university hospital career, making it impossible for a doctor to attain high levels of promotion unless he does some research (this could be done by asking doctors interested in such a career to work for several years in an INSERM laboratory after their training and before they take up clinical responsibilities); (ii) awarding clinicians, exceptionally, the status of research worker; (iii) increasing considerably the participation of the universities in financing medical research, a participation which at present is absurdly low and is every decreasing.


Client-oriented medicine.

Client-oriented medicine. Both weak (Illich) and strong (Kerr White, Cochrane) cases have been made for radical changes in medical education and medical practice. The real needs of patients and of the community are considered to be incompletely served by the prevailing emphasis on acute hospital medicine, to the comparative neglect of primary care in the community and of the needs of particular 'client groups', e.g. the mentally and physically handicapped, and the elderly. Inherent in this approach are emphases on information systems related to morbidity rather than to mortality; on 'care' rather than on 'cure'; on quality control relating to 'outcomes' rather than to 'structure' or 'process' of practice; and on controlled trials of both new and accepted forms of treatment. Difficulties in this approach include the taxonomic incongruity of 'client-group' statistics and the 'disease-system' categories of biomedicine; the therapeutic expectations of the consciously ill; the intellectual interest and the immediacy of specialized clinical practice; and the necessary and profitable links between medical science and the general corpus of science. Nevertheless, and in the full recognition that what is socially desirable may not be scientifically feasible, there is a need in the research context to explore methods of assessing the 'health service priorities' to be attached to biomedical categories. However, these priorities are in themselves multiple, and their relative weighting involves value judgements which are not completely quantifiable.


International coordination of biomedical research. Recent efforts at international coordination in biomedical research have taken place at two levels. At the level of the working clinician and scientist, European regionalism has become increasingly manifest in such organizations as the European Society for Clinical Investigation, the European Organization for Research into the Treatment of Cancer, the European Molecular Biology Organization and many others. These have developed largely, though not entirely, independently of government funding. At the level of science policy, i.e. of bodies supporting biomedical research mainly from public funds, the major developments have been the Comité de la Recherche Médicale of the European Community and the much wider association of European Medical Research Councils, based on the whole of Western Europe; in October 1975 the latter group became incorporated into the new European Science Foundation as the first Standing Committee of that body. Wider, interregional, cooperation presents greater problems, though there have been some modest successes, and the multinational drive on research into six of the major health problems of the Third World now being proposed by WHO holds further promise for the future.


Government needs and public expectations. The priorities for research which emerge from looking at the health needs of patients collectively are examined here. Priorities, however imperfect, are discernible when the five indices of where the main burdens on the health services lie are examined; those indices are inpatient days, outpatient referrals, general practitioner consultations, sickness-benefit days, and loss of life expectancy. Housing, employment, nutrition, etc., are equally relevant to health and to the question of priorities in medical research. It is important in dealing with government needs and public expectations to be clear what health and social services cannot do and what people must do for themselves.


General discussion: research, practice and education.


Delineation of clinical conditions: conceptual models of 'physical' and 'mental disorders. The dysfunctional consequences of the Cartesian dichotomy have been enhanced by the power of biomedical technology. Technical virtuosity reifies the mechanical model and widens the gap between what patients seek and doctors provide. Patients suffer 'illnesses'; doctors diagnose and treat 'diseases'. Illnesses are experiences of discontinuities in states of being and perceived role performances. Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems. Traditional healers also redefine illness as disease: because they share symbols and metaphors consonant with lay beliefs, their healing rituals are more responsive to the psychosocial context of illness. Psychiatric disorders offer an illuminating perspective on the basic medical dilemma. The paradigms for psychiatric practice include multiple and ostensibly contradictory models: organic, psychodynamic, behavioural and social. This mélange of concepts stems from the fact that the fundamental manifestations of psychosis are disordered behaviours. The psychotic patient remains a person; his self-concept and relationships with others are cental to the therapeutic encounter, whatever pharmacological adjuncts are employed. The same truths hold for all patients. The social matrix determines when and how the patient seeks what kind of help, his 'compliance' with the recommended regimen and, to a significant extent, the functional outcome. When physicians dismiss illness because ascertainable 'disease' is absent, they fail to meet their socially assigned responsibility. It is essential to reintegrate 'scientific' and 'social' concepts of disease and illness as a basis for a functional system of medical research and care.


Clinical science.

Clinical science. The most obvious achievements of clinical science have been in the elucidation of symptoms and signs and the patterns of disordered function due to failure of the organs or to nutritional disturbances. The benefits of clinical research are both direct--through improved practice--and indirect--through improved teaching and contributions to biological science. It is suggested that the clinical scientist, experienced in both clinical and research work, has a potential not to be expected from collaboration between non-scientific clinicians and non-clinical scientists. Problems which particularly affect clinical research include: ethics; difficulty in being experimentally rigorous; the need to be opportunistic; dependence on transient workers; excessive conern with the end stages of irreversible disease; triviality; uncritical and premature imitation of research in practice. Clinical science is always threatened by a tendency for its problems to be regarded simply as applied problems of basic science. The roles of the clinical scientist should include: elucidating clinical phenomena, about most of which we remain very ignorant; collaboration with basic scientists on the one hand and with community scientists on the other; and clarifying the description and analysis of illnesses.


The value to medical practice of basic and applied medical research done twenty years ago. Research can be justified in many ways besides the improvement of clinical practice--for example, by providing the intellectual excitement necessary for teachers and students. The value of present-day research cannot be assessed; but that of twenty years ago can be, at least in respect of current medical practice. An analysis has been made of all the papers published in 1956 in the American Journal of Physiology, the Journal of Physiology (London), the Journal of Clinical Investigation, and Clinical Science. This shows an overwhelming impact on current medical practice coming from clinical departments, and a comparatively very small influence of work coming from preclinical departments. If this conclusion is correct and generally applicable, it has some relevance to the funding of medical research.


Discussion: research and the cost of treatment.


Problem-solving in science.

Problem-solving in science. Problem-solving is a characteristic activity of scientists, Theoretical problems are formulated as a consequence of scientists' thirst for knowledge, and their solutions take the form of general propositions, termed hypotheses, which are consistent with, and provide provisionally satisfactory explanations of, empirical observations. Practical problems appear as the result of feedback from the extra-scientific world of everyday life, industry and professional practice. Their solutions provide an improved basis for decision-making in terms of existing options or increase the number of options from which a choice may be made. The categories theoretical and practical are not mutually exclusive: practical problems often generate interesting theoretical problems, and the solution of a theoretical problem may entrain the solution of a host of practical problems. All hypotheses are provisional because it is impossible to establish the truth of a generalization by rigorous deduction from any number of particular instances, though a single instance may suffice to refute it. This asymmetry forms the basis of Popper's analysis of scientific methodology. This analysis, though acceptable in the main, is open to criticism in the following respects; (1) it ignores the contribution to scientific progress made by unplanned perceptions; (2) it ignores the contribution of hypotheses which do not generate testable predictions; (3) it does not do justice to the extra-logical component in knowing (Polanyi's tacit dimension); and (4) its treatment of practical problems in inadequate.


Comparative pharmacokinetics of lividomycin, amikacin and sisomicin in normal subjects and in uraemic patients.


Variation in karyotype in Hemerocallis.

Variation in karyotype in Hemerocallis. Fifty two taxa have been studied, out of which forty five, including the species; H. citrina, H. dumortierii, H. multiflora, H. forrestii and H. thunbergil are diploid with 22 chromosomes in the somatic complement. H. fulva var. Europa, H. fulva var. cypriana, H. kwanso "Flore Pleno" and H. disticha "Flore Pleno" are triploid with thirty three chromosomes in the somatic complement. One cultivar "Mrs. David Hall" is tetraploid with forty four chromosomes. Besides this two aneuploid clones "Garden Lady" and cv. "29" with 2n=23 and 2n=29 chromosomes respectively were also encountered. Essentially four basic karyotypes are recognizable; A(IV + 8L + 1J + 1I), B(IV + 7L + 2J + 1I), C(9L+ 1J + 1I) and d(8L + 2J + 1I), where V stands for median, L for submedian, J for subterminal and I for terminal centromere. Thirty two taxa could be relegated to these four types and 17 can be resolved as combinations of these four types. These fall under AB, AC, AD or BC, BD and CD classes. The number of nucleolar chromosomes does not show any correlation with the grade of ploidy, whereas 2, 3 or  telocentric chromosomes were consistantly found in diploid, triploid and tetraploid taxa respectively. The possible origin of telocentric chromosomes and aneuploid taxa has been discussed.


Renal tubular transport of urate in man.


Psychosocial and medical effects of vasectomy in a sample of health plan subscribers. The effects of vasectomy on psychosocial adjustment assessed by interviews, and on physical health assessed by physicians and other medical personnel, were examined by comparing 33 vasectomized men with a matched group of 33 non-vasectomized men in a pre-paid health plan. Consistent with favorable self-reports in earlier studies, the vasectomized men experienced no greater marital, job, or general living stress than the non-vasectomized men. In fact the psychosocial adjustment of the vasectomized men appeared superior to that of the non-vasectomized men, perhaps because of reduced anxiety about unwanted pregnancy. The hypothesis advanced by some investigators that vasectomized men exaggerate their masculinity in an overcompensating maneuver to reduce a perceived threat to their masculinity was not supported; instead, men volunteering for vasectomy exhibited as many masculine traits prior to the operation as after it. There was no evidence that vasectomy led to either impairment or enhancement of medical health. 33 vasectomized men were compared with 33 nonvasectomized men who were members of the health plan at the Kaiser Foundation Hospital, Portland, Oregon. The 1st study used data from a structured interview to examine psychosocial adjustment,  masculinity, and rigidity. Little difference was found between the 2 groups except that vasectomized men reporter greater marital happiness and better health and appetite. This may be due to lack of worry about pregnancy. Health plan records  were examined for illness as part of the 2nd study. Both groups had similar treatment records and vasectomized men did not have more ailments with strong psychological components than nonvasectomized.


Psychiatric day hospital treatment of terminally ill patients. The psychiatric Day Hospital offers a forum for working out bereavement issues of terminally ill patients. Through individual and group psychotherapy, patients and their families are assisted in coping with the issues of death and dying. Coordination of medical, surgical, and psychiatric treatment of dying patients is enhanced by Day Hospital educational and treatment programs which afford continuity of care at the interface area between treatment specialties.


Teamwork: a multidisciplinary pediatric-liaison service. Psychiatrists, psychologists and social workers are often consulted about the same hospitalized patient. Since each may differ in their training, orientation and experience, the opinions expressed by them to the consultee may differ. The authors have described a multidisciplinary liaison team operating within a pediatric teaching hospital. The consultants work as a team in close collaboration with each other and with the psychiatric nurse clinician and an occupational therapist. The team approach has specific advantages. It allows for a concise and unified approach to the emotional and social needs of the patients. It presents a forum for informal consultations and interdisciplinary meetings. In addition, teaching opportunities are many as each discipline learns from the other.


The relationship between language and disease concepts. The Sapir-Whorf hypothesis, well-known in anthropological linguistics, postulates that language may not only describe the world we inhabit but also mould the way we experience it. This paper argues that an individual's language may similarly determine his conception of disease. Possible relationships between linguistic features and disease concepts are cited for the Eskimo, the Navaho, and the Chines, and it is suggested that, in European languages, the extensive use of spatial metaphors to express abstract concepts may encourage a more rigid categorization of disease and inhibit the ability to conceive of multiple factors in disease causation. The use of nouns rather than verbs to express the idea of illness could lead to a static view of disease and tends to separate illnesses as distinct entities rather than defining them as aspects of bodily functioning. The bipolar structure of Indo-European languages, setting subject against predicate and noun against verb, may play a part in the persistence of the mind-body dichotomy and restrict the holistic perception of man with nature. These linguistic features, in leading to a conception of disease as a rigidly defined, unchanging, unicausal thing, may encourage an over-use of surgery and lead to difficulty in perceiving social and psychological factors in disease.


The psychiatrist as teacher in primary care residency training: the first year. Increasing development of postgraduate primary care training programs to meet manpower needs is supported by flexibility in the Boards of Internal Medicine and Pediatrics to include experience in psychiatry; with this change, liaison psychiatrists will become progressively more involved and closely integrated into such training. This report outlines the first year experience of a psychiatrist in one innovative three year program in pediatrics and medicine, and describes some common problems and issues, along with teaching goals and some developing methodologies. Although the number of trainees in this first year cohort is small, preliminary results reported by a feedback component of an independent evaluation team attached to the program suggest that the interns are receptive to the psychiatric input and that they consider the initial contribution by psychiatry to have as much usefulness to their training in primary care as the more traditional pediatric and medical components.


The existential plight in cancer: significance of the first 100 days. The Existential Plight in cancer is a poorly recognized but significant period. It starts with the definite diagnosis and continues for two to three months into the illness, approximately 100 days. The chief signs are the predominance of life/death concerns, e-en over worries about health or physical symptoms. One hundred and twenty newly diagnosed cancer patients were interviewed, tested, and followed from about ten days after diagnosis at four to six week intervals until three to four months had elapsed. Plight was analyzed from the viewpoint of coping strategies, resolution of problems, vulnerability, total mood disturbance, and predominant concerns. Patients who had higher emotional distress during this period had many regrets about the past, were pessimistic, came from a multiproblem family, and had marital problems. The widowed or divorced had higher vulnerability, as did patients who anticipated little or no support from significant others. Although vulnerability increased with advanced staging and many symptoms, at the time of diagnosis psychosocial distress crossed diagnostic and prognostic boundaries, enabling investigation to predict within limits those patients who will cope effectively or fail to cope with cancer and its ramifications.


Psychoanalysis applied to medicine: a personal note. The psychoanalyst has much to contribute to medicine, more through the teaching of observational skills and an appreciation of relationships than through the teaching of psychoanalytic technique or languate itself. The analyst can promote tolerance in the physician of the unusual, an examination of the impediments of habitual ways of working and seeing, and a facility in the patient to "be himself". Attention to the unusual, as illustrated through experience in training-cum-research seminars, can enhance the doctor's satisfaction with his professional life while offering improved care to his patients. When psychoanalyst, physician and patient interact in their roles as people, there is hope of an improved quality of human existence for all.


Pharmaco-histochemical studies on a specific monoamine in the gustatory epithelia of the rabbit. The foliate, vallate and fungiform papillae of the rabbit's tongue were studied fluorescence-histochemically under normal and experimental conditions. In normal animals a yellow fluorescence suggesting the presence of a serotonin-like monoamine was demonstrated only in taste bud cells of the foliate papilla, though its intensity was very weak. The fluorescence disappeared completely following reserpine treatment, while it was significantly enhanced by the treatment with nialamide. The fluorescence of taste bud cells could be clearly distinguished from that of catecholamines by the treatment with alpha-MMT followed by nialamide. When 5-HTP, 5-HT and 5,6-DHT were administered separately, each of these drugs was selectively taken up in taste bud cells of the foliate and vallate papillae, but no fluorescent cells were observed in the fungiform papilla. From the present results, it seems reasonable to conclude that the fluorigenic amine of taste bud cells may be 5-HT (serotonin), or at least an indoleamine derivative. Also, it is suggested that the taste bud of the vallate papilla contains a cell type which can potentially synthesize a biogenic amine in situ, or is actually synthesizing it in a very small amount just like in the case of the taste bud of the foliate one.


An unusual adverse reaction to self-medication with prednisone: an irrational crime during a fugue-state. During five years of self-medication with Prednisone, a forty-one-year old asthmatic businessman experienced periods of euphoria, psychomotor hyperactivity, and poor judgement; a period of depression and anxiety during temporary steroid withdrawal; and finally, with resumption of Prednisone, episodes of grandiosity and bizarre fugue-like behavior, with adoption of a second identity and culminating in an irrational crime. Steroids were then withdrawn, and the patient resumed his premorbid personality, but had amnesia for much of his previous behavior. The literature on hysterical fugues and corticosteroid-induced mental disturbance is reviewed. The patient's reactions are analyzed in terms of his premorbid neurotic conflicts, the psychological stresses acting upon him, and the effects of Prednisone on his central nervous system.


Psychiatric status of diabetic youth in good and poor control. Two groups -- identified as "good control" and "poor control" -- of 40 diabetic youth, between 6 years and 18 years, matched for age, sex and duration of diabetes, were interviewed by a child psychiatrist who was not aware of the status of their diabetic control. After each interview psychiatric diagnoses, interpersonal conflicts and noninterpersonal conflicts were determined. At the same time, mothers completed a children's behavioral-emotional symptom checklist. Six psychiatric diagnoses were made (7 1/2 per cent occurrence): four in the poor control group and two in the good control group, not a significant difference. Fifty per cent of the psychiatric diagnoses were found in the prepubertal girls who had the earliest onset of diabetes. A significantly greater number of patients in poor control had interpersonal conflicts compared with patients in the good control group. Mothers of patients in poor control had checked significantly more behaviors as slight and considerable-severe problems compared to mothers of patients in good control. Five per cent of the patients in good control and fifteen per cent of the patients in poor control stated that they experienced a "different" self-image because of their diabetes. The frequency of psychiatric diagnoses (7 1/2 per cent) for the entire group was not higher than literature reports of serious psychiatric disorders in normal population studies.


Quality and quantity assurance.

Quality and quantity assurance.


Polyacrylamide gel technique for the histochemical demonstration of soluble enzymes. Soluble enzymes were immobilized and visualized by polyacrylamide gel slabs, impregnated with the incubation medium including auxiliary enzymes. The method has several advantages over existing techniques which make use of gel films or a semipermeable membrane. The diffusion of tissue compounds is effectively limited, while auxiliary enzymes may be operative. Moreover the viscosity of the medium is temperature-independent so that the incubation temperature can be varied. To demonstrate the suitability of the method glycerol-3-phosphate dehydrogenase, lactate dehydrogenase, glucose-6-phosphate dehydrogenase, hexokinase, phosphoglucomutase and aldolase were visulaized in human or rat skeletal muscle. Cytosolic and mitochondrial glycerol-3-phosphate dehydrogenase were both visualized in the absence of added NAD+ and menadione. For the visualization of ATP producint enzymes, like creatine kinase and pyruvate kinase, the method is not suitable.


Genetic knowledge client perspectives, and genetic counseling.


Absorption cytophotometry: evaluation of three methods for the determination of DNA in Feulgen stained nuclei. Three methods for the evaluation of the relative amount of DNA per nucleus by absorption cytophotometry are compared. A combination of the two-wavelength method (Patau, 1952; Ornstein, 1952), the one-wavelength two-area method (Garcia, 1965) and the determination of transmission through nuclear plugs is proposed in order to estimate systematic errors made by absorption cytophotometry.


Consultation in the intensive care nursery. The paper describes a group-oriented mental health consultation program which was established for the staff of a pediatric special care nursery. The initial phase of consultation was designed 1) to deal with work stresses in providing acute medical care for premature infants who are at high risk for later emotional and developmental disturbances; and 2) to facilitate intrastaff communication in an atmosphere of strenuous physical demands from patients, and moral dilemmas raised by infants' life-threatening conditions. Also discussed are problems experienced by staff in providing psychological support to families of hospitalized infants. The author reviews implications for crisis intervention to help mitigate families' mental stress and to facilitate the emotional attachment to their infants.


Interpersonal resistance to change: a study of a fat woman who became thin. The paper reports on the psychoanalytically-oriented psychotherapy of a very obese woman who, after a rather prolonged therapy, "decided" to reduce. During the weight loss process, significant reactions were noted from her son, daughter, brothers, sisters-in-law, customers, employees, husband, and therapist, which became crucial interferences with the continuing weight loss and specific resistances in the therapy. The identification of and the working through of these resistances significantly increased and consolidated her self-understanding. In that the response to major psychological changes was minimal as compared to the response to her physical change, it is hypothesized that physical change is more basically related to sense of self-continuity and hence more threatening to experience and observe.


A new approach to building social work knowledge. A vehicle such as an information reporting and summarization system (IRSS) is needed to assist social workers in building social work knowledge. The IRSS moves toward this goal in two important ways: (a) by requiring that social workers strive to formulate unambiguously detailed categories and classifications for use in making descriptive generalizations of their individual cases; and (b) by enabling social workers to generate descriptive generalizations extending over a multiplicity of cases. In this way it provides social workers with the kinds of empirical data necessary to verify and build thier knowledge.


Evidence of reservior hosts of Brucella mellitensis. Serological reactors to Brucella melitensis were found among goats and eland in Chilanga. The only clinical evidence of disease were abortion among the goats, and circumstances did not allow for isolation of the organism in the laboratory. No gross pathological lesions were observed on post mortem examination of the goats. The public health significance relates to the ease of Br. melitensis transmission between reservoir hosts and human beings.


On the subsarcolemmal localization of phenazine ethosulfate-linked alpha-glycerophasphate dehydrogenase activity in pigeon pectoralis white muscle fibres. In this study frozen sections of avian striated muscles were incubated for mitochondrial alpha-glycerophosphate de hydrognease (alpha=GPD) reaction, and the effect of menadione, phenazine methosulfate (PMS) or phenazine ethosulfate (PES) as intermediate electron acceptors was evaluated. Under histochemical conditions, PMS or PES-linked alpha-GPD reaction was poor in the chicken posterior latissimus dorsi and chicken pectoralis muscles. However, PMS or PES-linked alpha-GPD reaction was present characteristically in the subsarcolemmal mitochondria of the "broad white" fibres of the pigeon pectoralis muscle only; the subsarcolemmal mitochondria of the narrow red fibres lacked such a reaction pattern. The above reaction pattern, however, differed when compared with the menadione-linked alpha-GPD reaction. The present histochemical evidence suggests the existence of an inherent heterogeneity in the mitochondrial populations of the different avian striated muscle fibres studied.


Consultation with community care facilities. An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically mentally ill persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference with work efficiency are described by examining realistic conflict resolutions utilizing problem clarification, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.


Initiation of a quality assurance program for social work practice in a teaching hospital. This first-stage paper describes the steps taken in implementing a quality assurance program. The rationale for writing social work protocols based on medical diagnosis or tasks rather than on psychosocial diagnosis is explained in detail. Protocols for adult rheumatoid arthritis, pediatric cancer, adult discharge planning, and adult nursing home placement are included to demonstrate the result of the medical diagnosis/task approach.


Interprofessional education and social work: a survey. In 1974, the author surveyed all graduate schools of social work to determine how team concepts were being introduced to master's degree level students. A 76% response rate was achieved; 31% of the schools offered joint courses with other professional schools, 17%  offered courses on teamwork itself within the school of social work, 10% had virtually no content on interprofessional collaboration, and the majority attempted to introduce this content through the practicum and the overall curriculum, especially health courses. These modalities are further described along with advantages and disadvantages of various approaches.


Interdisciplinary education for health professionals: issues and directions. With the increasing use of the team approach in health care delivery, many patterns of team practice have evolved. There is cumulating concern about how comprehensive care can be delivered and how to train health professionals for this model. Educators and practitioners and examining and experimenting with approaches to holistic training. This paper summarizes some of the issues in interdisciplinary training of health professionals and makes a number of recommendations.


Prematurity.

Prematurity.


Bancroftian filariasis. An autochthonous case in Zambia. The first report of an autochthonous case of Wuchereira bancrofti in Zambia is presented. Observations are made on the diagnostic features of the microfilatiae particularly in relation to their periodicity and aggulutination in sequestrinated blood. The criteria used to identify the worms in section and the problems in diagnosis are outlined. Though imported cases have also been diagnosed it is considered that bancroftian filariasis is probably endemic. Further comprehensive investigations are recommended in ecologically transmissable areas.


Family counselors in a pediatric specialty clinic setting. Numerous studies point up the psychosocial needs of chronically ill children, as well as the fragmentation or lack of services to meet these needs. Following an earlier study demonstrating the effectiveness of nonprofessional family counselors in improving the self-concept of children with chronic illness, this project placed five counselors in the pediatric specialty clinics of a teaching hospital. They were well accepted by all professional staff, and they provided a variety of services for families, improved communication among and coordination of care givers, and felt satisfaction in this role. This program provided an important expansion of social work services at low cost.


Singleton breach presentation planned for vaginal delivery. A retrospective study of 156 consecutive cases of singleton breach presentation planned for vaginal delivery is presented. The incidence of caesarean section was not increased when compared with that for all Hospital and Clinic confinements. The perinatal mortality and prematurity rates were high. The incidence of cord prolapse was increased especially with the footling breech. The need for an experienced Obstetrician and Anaesthetist to conduct all deliveries was demonstrated. Factors influencing the assessment of feto-pelvic proportion and the occurrence of trauma and asphyxia in the management of breech labour and delivery are discussed. The continued place of external cephalic version is justified by the perinatal mortality rate.


The treatment of trichomonal vaginitis using single dose tinidazole (Fasigyn-Pfizer). A total of twenty eight patients living in a around the City of Lusaka, Zambia were subjected to a drug trial to determine the effect of a single oral dose of Tinidazole (Fasigyn Pfizer) in the treatment of Trichomonal Vaginitis. All the twenty eight patients were proven cases of Trichomonal Vaginitis from microscopy of cervical smears. Two grammes of Fasigyn were used as a single oral dose with yeast as Placebo. Twenty patients were originally treated with Fasigyn and eight received yeast. However two patients in the Fasigyn group absconded, but one later reported satisfactory results. The husbands of two others were untreated. Four patients had other vaginal infections. A microscopic cure rate of 100% and a corrected clinical cure rate of 93.3% was obtained using fasigyn. The side effects were minimal and the patients themselves regarded them as mild.


The risk of birth defects: Jacobs v. Theimer and parents' right to know. This Article discusses the Texas Supreme Court's holding in Jacobs v. Theimer that the parents of a defective child had a cause of action for damages against a physician for alleged negligent failure to inform the mother during pregnancy that she had contracted rubella and therefore might have a defective child, thereby causing her to lose the opportunity to have an abortion. The Article raises a number of questions that post-Jacobs courts probably will confront concerning the duty of physicians and genetic counselors to keep their clients informed; describes some social and medical developments--including recent progress in medical genetics and prenatal diagnosis--which are likely to make Jacobs a significant precedent; evaluates the court's decision to allow a damage suit only for the costs of treating and caring for the child's defects; and briefly addresses the question of whether the Jacobs case comes within the sphere of suits for what has come to be known as "wrongful birth" and "wrongful life."


Rabies in Zambian children.

Rabies in Zambian children. Human rabies encephalitis is of particular interest of the doctors working in developing countries. When a person has been exposed to a suspect or rabid animal or human being specific antirabid treatment should be given. Ten of the twelve rabid children seen at Arthur Davison Hospital for Children over a 6 year period are described and the literature on treatment reviewed.


Statement on antidiscrimination regarding sexual orientation.


Liability of manufacturers and providers of health related goods and services: confronting the dilemma. In this Article, Theodore Cooper, M.D., Assistant Secretary for Health at HEW, contends that the crush of lawsuits brought by aggrieved health care consumers against medical professionals and institutions, and drug and medical equipment manufacturers, may be the result, in large part, of a widely held impression--often encouraged by members of the health professions and industries themselves--that medicine has unlimited powers to heal. Dr. Cooper suggests that those involved in providing health care services and products--and members of the legal profession-have a responsibility to inform the public that this expectation is unrealistic and that everyone suffers when the number of such lawsuits and the size of damage awards are excessive.


The Puerto Rican lesbian and the Puerto Rican community.


A social episode model of human sexual behavior. A social episode model of sexual behavior is proposed with emphasis placed on arousal as a crucial variable. This model argues against a disease or deficiency concept of homosexuality. However, the authors also hold that it may be coercive to push clients to accept their homosexuality, and that a therapist should adequately respond to a valid sexual orientation request. The social-sexual episode is divided into two relatively independent stages, preparatory and consummatory. A mathematical analysis is included, and the model is related to Freeman and Meyer (1975) wherein changes in sexual preferences were successfully made. Other validation sources for the model are presented.


The so-called "inappropriate" psychiatric consultation request on a medical or surgical ward. Seven cases of psychiatric consultations on medical and surgical wards are reviewed to show how intrapsychic conflicts in the staff may make the consultation request appear inappropriate. On deeper examination, such requests may signify staff dysfunction caused by arousal of conflictual feelings about the behavior of illness of the patient. Mutilated, mute patients appear to arouse fear of agression in their caregivers, who in turn reject such patients, see them as alien and violent, and become illogical in their management. Patients who publicly display sexual behaviors appear to arouse shame over exhibitionism, voyeurism, and masturbation; their caregivers become too passive to effect common-sense measures appropriate to the situation. Very sick and dying patients and ungrateful, demanding patients can arouse anger and despair. Their caregivers may become depressed about failure, feeling helpless and out of control; using projection, they can see such patients as evil or suicidal, and may eventually turn against themselves. The psychiatric consultant, recognizing the conflicts that make the requests seem inappropriate, seeks to substitute higher-level cognitive operations and coping behaviors in the staff (distancing, rationalization, intellectualization, undoing, and altruism) for distortion projection, over-identification, reaction formation, and turning against the self.


Female sexuality and the role of the phallus.


On the validity of typologies of gay males. The classical dichotomization of male homosexuals into passive and active or insertee and inserter types is tested against empirical evidence. Data on the sexual preferences of 243 male homosexuals are analyzed to determine the extent to which they fit the insertee-inserter dichotomy. The fit between the dichotomy and the data is found to be very poor. The most popular set of sexual preferences is for all roles combined, both active and passive anal and oral. It is suggested that the concepts of oral and anal may better characterize the sexual preferences of male homosexuals than those of insertee and inserter. A variety of complex interaction effects among sexual preferences are also reported.


A psychiatrist's experience in a primary health care setting. Psychiatrists have, for years, offered consultation to their nonpsychiatrist colleagues in many settings and have worked with them in a variety of ways. The development of new programs in primary medical care offers new challenges and opportunities to the liaison psychiatrist. This paper describes the experience of a full-time psychiatrist in a hospital-based primary health care setting. Special problems are encountered in developing working relationships with patients, physicians, nurses, social workers, administrators, and other members of the health care team. Effective resolution of these problems makes it possible to offer comprehensive mental health services as an integral part of primary health care. This psychiatrist's role differs from other consultation-liaison functions by virtue of full-time economic, patient care, academic, geographic and administrative assimilation into the primary health care setting itself. It is suggested that this role is an effective way to bring supportive and educational psychiatric services to patients and providers of all levels of sophistication and need.


Mirroring: one vehicle to organizational clarity.


Analysis of public attitudes toward homosexual behavior. Data from a 1974 representative survey of the white American adult population indicate that most white Americans (75%) disapprove of homosexual relations. Those persons who tend to hold more favorable attitudes toward homosexual relations are those under 30 years of age, those living in larger urban centers, and those with college experience.


Comment: litigation involving manufacturers' liability for defective medical products: judicial perspectives. In this Comment, Judge Rosenn discusses, from a judicial perspective, the development of manufacturer's liability for defective medical products, with particular attention to the evolution of the strict liability doctrine, the courts' willingness to apply that doctrine to medical manufacturers, and recent suggestions for seriated trials as a means of more effective resolution of the complex litigation that arises in cases of alleged faculty design of medical products.


Melville's The Confidence Man: a "poisonous" reading.